Treatment of acne with spironolactone: a retrospective review of 395 adult patients at Mayo Clinic, 2007–2017

Abstract

Background Few large studies have assessed spironolactone treatment of adult female acne. Objectives To explore the role of spironolactone in the treatment of adult female acne. Methods We performed a retrospective case series assessing the efficacy of spironolactone treatment of a cohort of women evaluated at Mayo Clinic in Rochester, Minnesota, from 2007 through 2017. Results In total, 395 patients (median age, 32 years) received a median spironolactone dose of 100 mg daily. Approximately two‐thirds of patients (66.1%) had a complete response; 85.1% had a complete response or a partial response greater than 50%. Median times to initial response and maximum response were 3 and 5 months. Efficacy was observed across all severity subtypes of acne, including those with papulopustular and nodulocystic acne. Patients received long‐term treatment with spironolactone (median duration, 13 months) and had few adverse effects. Conclusions Spironolactone is a safe and effective treatment of acne for women.

Use of spironolactone to treat acne in adolescent females

“…We have previously reported on the safety and efficacy of spironolactone in the treatment of acne for adult women. 6 The median age of patients in this study was 19 years, which is relatively high for adolescents. This may be due to hesitancy on the part of the parent and/or physician to start an oral medication in younger patients.…”

“…Response to spironolactone treatment in 80 adolescent patients, stratified according to acne grade As noted in our adult study, blood pressure variations have been previously reported with spironolactone therapy; however, this value was not routinely measured in our practice unless patients noted symptoms of lightheadedness, dizziness, or had concerns regarding low blood pressure. Such symptoms were infrequent in our patient cohort 6. …”

“…Per the previous methodology in our cohort of adult women, potassium levels or blood pressure was not routinely monitored in these patients unless the patient experienced symptoms or there were reasons for concern. 6…”

“…Of the 10 patients (out of 80 patients, 12.5%) that started an OCP <6 months before Characteristics of 80 adolescent patients with ≥3 mo of spironolactone treatment Portions of this table are adapted from our retrospective review which was published in the J Eur Acad Dermatol Venereol. Permission to reuse was obtained 6. Abbreviations: OCP, oral contraceptive pill; PCOS, polycystic ovary syndrome.…”

Spironolactone in dermatology: uses in acne and beyond

“… 3 A further case series 4 ( n = 395) advocated the use of spironolactone (100 mg/day) in adult acne. Following a median treatment duration of 13 months, 66.1% of patients had a complete response, and 85.1% had a complete or partial response of > 50% 5 . A positive response to spironolactone was related to a high number of inflammatory lesions at baseline (odds ratio = 1.08; 95% confidence interval 1.03–1.13; P = 0.001) 4 …”